BackgroundThe transition from medical student to hospital-based first year junior doctor (termed “intern” in Australia) is known to be challenging, and recent changes in clinical learning environments may reduce graduate preparedness for the intern workplace. Although manageable challenges and transitions are a stimulus to learning, levels of burnout in junior medical colleagues are concerning. In order to prepare and support medical graduates, educators need to understand contemporary junior doctor perspectives on this transition.MethodsFinal-year University of Queensland medical students recruited junior doctors working in diverse hospital settings, and videorecorded individual semi-structured interviews about their transition from medical student to working as a junior doctor. Two clinical academics (NS and JT) and an intern (ZT) independently conducted a descriptive analysis of interview transcripts, and identified preliminary emerging concepts and themes, before reaching agreement by consensus on the major overarching themes.ResultsThree key themes emerged from the analysis of 15 interviews: internship as a “steep learning curve”; relationships and team; and seeking help. Participants described the intern transition as physically, mentally and emotionally exhausting. They learned to manage long days, administrative and clinical tasks, frequent interruptions and time pressures; identify priorities; deal with criticism without compromising key relationships; communicate succinctly; understand team roles (including their own status within hospital hierarchies); and negotiate conflict. Participants reported a drop in self-confidence, and difficulty maintaining self-care and social relationships. Although participants emphasised the importance of escalating concerns and seeking help to manage patients, they appeared more reluctant to seek help for personal issues and reported a number of barriers to doing so.ConclusionFindings may assist educators in refining their intern preparation and intern training curricula, and ensuring that medical school and intern preparation priorities are not seen as competing. Insights from non-medical disciplines into the organisational and relational challenges facing junior doctors and their health-care teams may enhance inter-professional learning opportunities. Workplace support and teaching, especially from junior colleagues, is highly valued during the demanding intern transition.

Students and faculty benefited from their SP experience. A combination of SP types can provide a broad range of cost-effective preclinical learning experiences. Students, faculty, and actors as SPs each have specific strengths and weaknesses related to cost, training needs, feedback quality, and simulation fidelity. The goals of the encounter should guide the choice of SP type.

This article describes the development, implementation, and evaluation of a curriculum project designed to prepare medical students to care for populations who have Medicaid or a low socioeconomic status (SES). The setting for the project was a community-based medical school, the College of Human Medicine (CHM) at Michigan State University. This article describes a four-year process of curriculum development and offers examples of specific changes that CHM made to courses and clerkships. CHM modified 25% of preclinical courses, five core clerkships of year three, and two clerkships (Senior Surgery and Senior Internal Medicine) of year four. The authors describe highlights of outcomes in student performance, course and clerkship ratings, attitudes, professional goals, student self-assessment of their skills, and feedback from residency program directors. The authors identified four items on the Association of American Medical Colleges (AAMC) Graduation Questionnaire as related to the project and tracked them as an outcome measure of student attitudes related to the social responsibility of physicians. Attitudes of the students who experienced the modified curriculum showed greater agreement with AAMC Graduation Questionnaire items than the previous class at CHM and than their classmates across the country. The majority of residency program directors rated CHM graduates as more skilled than their peers in applying cultural competence, working with patients who have Medicaid or a low SES, and using community resources. The authors discuss factors that contributed to the successful implementation of curricular changes as well as challenges to their implementation.